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doi: 10.1177/0009922818813568pmid: 30449155
Given the medical home model of care’s (MHMOC) potential to reduce disparities in health care, this study determined the relationship between MHMOC, MHMOC indicators, and (1) demographic characteristics and (2) health outcomes in US children. Caregivers (n = 50 212) of children 0 to 17 years completed the 2016 National Survey of Children’s Health. The MHMOC measure comprised 5 indicators (e.g., having a personal doctor/nurse and receiving family-centered care). Bivariate and multiple logistic regressions assessed the relationships between MHMOC, MHMOC indicators, and (1) demographic characteristics and (2) health outcomes. Approximately 49% of the children were served in a MHMOC. MHMOC and MHMOC indicators were related to race, ethnicity, nativity, caregiver education, federal poverty level, insurance type, and predicted health outcomes. These findings suggest that children most in need of MHMOC are less likely to be served in them. Thus, the current distribution of MHMOC likely contributes to greater disparities in care.
Needlman, Robert D.; Dreyer, Benard P.; Klass, Perri; Mendelsohn, Alan L.
doi: 10.1177/0009922818822975pmid: 30614260
Attendance at well-child visits (WCVs) is a sine qua non of preventive care. We hypothesized that Reach Out and Read (ROR) would be associated with better WCV attendance. Parents of children 76 to 72 months at 8 clinics who did not yet have ROR reported how many WCVs their child had attended in the previous year; separate samples at the same clinics were interviewed 16 months after the ROR program was instituted. Comparing 267 parents before ROR and 254 after, the percentage who had attended the minimum number of WCVs required by the American Academy of Pediatrics periodicity schedule rose from 67.4% (180/267) to 78.3% (199/254; P < .01). This difference remained significant after controlling for multiple potential confounding factors (estimated odds ratio = 2.1, 95% confidence interval = 1.3-3.5). The largest differences were among Latino children and children of less-educated parents. Programs to enhance early literacy may increase attendance at WCVs among at-risk families.
Ericksen, Ryan T.; Guthrie, Cecilia; Carroll, Timothy
doi: 10.1177/0009922818816432pmid: 30547669
Objectives. Viral bronchiolitis is a frequent cause of pediatric hospitalization and respiratory failure. Procalcitonin (PCT) is a biomarker used to identify serious bacterial infection and can distinguish bacterial and viral infections. Concomitant bacterial pneumonia is not rare in viral bronchiolitis and can lead to a worse clinical course. This study examined the use of PCT in pediatric patients with respiratory failure attributed to viral bronchiolitis to predict concomitant bacterial pneumonia. Methods. This prospective descriptive study evaluated children less than 4 years of age who underwent endotracheal intubation for respiratory failure due to viral bronchiolitis. PCT levels and endotracheal aspirate cultures were obtained at admission. Bacterial pneumonia was defined as at least moderate growth of a single pathogenic organism from endotracheal culture. PCT levels were evaluated in groups with and without concomitant bacterial pneumonia. Results. Thirty-five patients were enrolled between February 2013 and May 2015. All subjects tested positive for at least 1 viral pathogen by nasal wash polymerase chain reaction or enzyme immunoassay. The top viruses obtained were respiratory syncytial virus (n = 15, 42.8%) and rhinovirus (n = 8, 22.9%). The incidence of bacterial pneumonia was 60% (21/35). The PCT median was 0.93 ng/mL (interquartile range = 0.25-6.64) in the bacterial pneumonia group and 1.85 ng/mL (interquartile range = 0.28-7.94) in the nonbacterial pneumonia group. No correlation was found between PCT and bronchiolitis with bacterial coinfection (P = .74). Conclusion. Incidence of bacterial coinfection in patients with respiratory failure and viral bronchiolitis was high. PCT did not predict concomitant bacterial pneumonia in children with viral bronchiolitis.
Brown, Maria D.; Rausch, Joseph; Berlan, Elise D.
doi: 10.1177/0009922818813571pmid: 30453767
A dearth of research exists examining provider adherence to preventative health care guidelines at adolescent well-care visits. We examined adherence in 3 domains: documentation of sexual activity, documentation of menstrual characteristics, and administration of the human papillomavirus vaccine. We identified electronic health records of a random sample of 124 adolescent girls seen within the hospital-affiliated pediatric primary care clinics from July 1, 2014, to June 30, 2015. Approximately one quarter of the records examined had no documentation of sexual activity. Documentation occurred more frequently in English speakers (P = .003). Asian girls had the least documentation of sexual activity (P = .003). Clinicians documented menses characteristics in only 27% of adolescent girls with no documentation noted for Asian adolescents. Over 40% of eligible adolescents did not receive the human papillomavirus vaccine. Only 19.4% of adolescents received all the 3 recommended services. This study demonstrates that adolescent girls are not receiving recommended assessments or care to protect their reproductive health.
Chan, K. Ning; Silverstein, Anna; Bryan, Leah N.; McCracken, Courtney E.; Little, Wendalyn K.; Shane, Andi L.
doi: 10.1177/0009922818812480pmid: 30463434
Acute otitis media (AOM) is a leading cause of health encounters and antimicrobial prescriptions in children worldwide. We assessed (1) the rates of antimicrobial prescribing by pediatric emergency department clinicians using a smartphone otoscope device as compared with a conventional otoscope and (2) clinician acceptability of the smartphone device. We conducted a randomized control study in children’s hospital emergency departments over 6 months. More than 1500 encounters were analyzed. The odds of prescribing antibiotics after being given a diagnosis of AOM by clinicians assigned to the smartphone group was 11% higher than the conventional group (18.8% vs 18.0%, odds ratio = 1.106, P = .600). Eight (73%) of the 11 physicians in the smartphone group preferred the smartphone device over the conventional otoscope. Use of a smartphone otoscope for detection of AOM in a pediatric emergency department setting did not lead to an increased likelihood of AOM diagnosis.
Lee, ChangWon C.; Holder-Niles, Faye F.; Haynes, Linda; Chan Yuen, Jenny; Rea, Corinna J.; Conroy, Kathleen; Cox, Joanne E.; Bottino, Clement J.
doi: 10.1177/0009922818812479pmid: 30461298
There is growing emphasis on using patient-reported outcome measures to enhance clinical practice. This study was a retrospective review of scores on the Childhood Asthma Control Test (C-ACT) and the Pediatric Symptom Checklist-17 (PSC-17) at a pediatric primary care center in Boston, Massachusetts. A total of 218 patients were selected at random using billing codes for well-child (WC) care and asthma, excluding complex medical conditions. Cutoff scores were used to identify uncontrolled asthma (C-ACT ⩽19) and clinically significant psychosocial symptoms (+PSC-17). Multiple logistic regression was used to measure associations between C-ACT ⩽19 and +PSC-17, adjusting for covariates. In multivariable analysis, C-ACT ⩽19 at WC visits was associated with +PSC-17 at WC visits (adjusted odds ratio = 3.2 [95% confidence interval = 1.3-8.6]). C-ACT ⩽19 at non-WC visits was also associated with +PSC-17 at WC visits (adjusted odds ratio = 3.1 [95% confidence interval = 1.2-8.9]). Patient-reported outcome measures of asthma control and psychosocial symptoms were positively correlated in this sample.
doi: 10.1177/0009922818816421pmid: 30501501
Background. Prior reports on large congenital melanocytic nevi (LCMN) do not provide a clear management approach to physicians to advise parents or patients. Whether the presence of a halo around the nevus can guide management has not been fully explored. Design. Children born with an LCMN were observed without active intervention. Objectives. (1) To guide physicians, health providers, and parents in the management of CMN. (2) To ascertain the value of the absence or presence of a halo component of the nevi. (3) To reaffirm the diagnostic value of dermoscopy for evaluation of CMN. Materials and Methods. This was a clinical study of 45 children referred to our pediatric dermatology clinics from 1971 to- 2018. Results and Outcome. Of 45 children, 9 were lost to follow-up and 36 were followed for 6 months to 47 years. In follow-up of 17 children with a scalp CMN, spontaneous regression occurred in 6 patients. In follow-up of 5 children with a trunk LCMN, spontaneous regression occurred in 1 patient and excisional surgery was done in 4 patients. Quality of life was excellent in 35 children, but poor in 1 patient during multiple injections and excisions. Conclusions. A conservative approach to management of children with CMN, large and small, is safe, cost-effective, and results in excellent quality of life and cosmetic outcomes. Dermoscopy, a simple in-office procedure, can reassure the examiner that the congenital nevus is benign. A halo rim was present in 12 (80%) of 15 scalp CMN. The presence of a halo rim appears predictive of future regression of a CMN in the scalp or trunk.
Levi, Jessica; Basa, Krystyne; Wong, Kevin; Morlet, Thierry; O’Reilly, Robert
doi: 10.1177/0009922818816426pmid: 30501502
Retrospective chart review of 248 children (1-19 years old) with tinnitus who presented to a tertiary pediatric hospital between 2006 and 2011, looking at which cofactors are predictors of pediatric tinnitus. In our review, we extracted demographics, symptoms, historical data, imaging, and laboratory results; we compared with the general population. Eighty-seven percent had normal hearing. Age distribution, noise exposure, and frequency of psychiatric diagnoses in our cohort were consistent with previous reports. We found a lower incidence of otitis media and the same prevalence of dizziness, asthma, and hearing loss as the general population, a lower prevalence of Eustachian tube dysfunction, otitis media, headaches, and higher incidence of rhinosinusitis. Lack of patient reporting and objective testing complicate the ability to detect pediatric tinnitus. We revealed a gap in the literature regarding rhinosinusitis as a cofactor, imaging during diagnosis, and if psychiatric diagnoses are associated with tinnitus in younger children.
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